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pancreas divisum
Etiology:
- failure of embryologic fusion of ventral & dorsal parts of the pancreas
Epidemiology:
- most common congenital anatomic variant of the pancreas
Pathology:
1) pancreatic drainage is accomplished mainly through accessory papillae
2) NOT a predisposing condition for pancreatitis in most patients
3) dorsal duct obstruction may predispose to acute pancreatitis
Special laboratory:
- endoscopic retrograde cholangiopancreatography (ERCP)
1) cannulation of dorsal duct is not as easy as ventra duct
2) appearance may be confused with an obstructed main pancreatic duct secondary to a mass lesion
Radiology:
- magnetic resonance cholangiopancreatography (MRCP) can detect pancreas divisum
Management:
1) conservative measures - observation [2]
2) pancreatic enzyme therapy if evidence of pancreatic exocrine deficiency
3) endoscopic or surgical intervention
a) when conservative measures fail
b) marked dilation of the dorsal duct
Related
endoscopic retrograde cholangiopancreatography (ERCP)
pancreas
pancreatitis
General
abnormal morphologic structure (malformation)
pancreatic disease
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 1532
- NEJM Knowledge+
- Liao Z, Gao R, Wang W, Ye Z, Lai XW, Wang XT, Hu LH, Li ZS.
A systematic review on endoscopic detection rate, endotherapy, and surgery for pancreas divisum.
Endoscopy. 2009 May;41(5):439-44.
PMID: 19337962 Review.
- Rustagi T, Njei B.
Magnetic resonance cholangiopancreatography in the diagnosis of pancreas divisum:
a systematic review and meta-analysis.
Pancreas. 2014 Aug;43(6):823-8.
PMID: 24743381 Review.
- DiMagno MJ, Wamsteker EJ.
Pancreas divisum.
Curr Gastroenterol Rep. 2011 Apr;13(2):150-6.
PMID: 21222060 PMCID: PMC307941 Free PMC article. Review.